Cultural influences in Post-Traumatic Stress Disorder Symptoms in Palestinians in the Gaza Strip
Abdel Aziz Mousa Thabet and Eyad El Sarraj - 1992

Over the last 25 years the Palestinians in the Gaza Strip and West Bank have suffered a variety of traumatic events, including witnessing violence, beatings, imprisonment, shooting, night raids, and torture.  Here in the Gaza Strip and West Bank the people face repeated and continuous trauma.

Many studies have been published about the psychological effect of trauma on human beings.  The most common symptoms recorded were nightmares, anxiety, depression, loss of concentration, hypersensitivity to noises, aggressiveness, sexual dysfunction, sleep disturbances, and fatigue (Allodi, 1982; Wallach & Rasmussen, 1983,1990; Ablidgaard et al, 1984; Domovitch et al, 1984; Somnier & Genefke, 1986; Mollica, R, et al, 1987; Solomon, 1989;).

Methodology
Our study sought to explain the type and frequency of traumatic events of patients treated at G.C.M.H.P and the symptomatology of Post-Traumatic Stress Disorder, and  whether there are cultural influences in showing Post-Traumatic Stress Disorder symptoms.

The sample of the study involved all adults (No:130) treated at G.C.M.H.P (Gaza Community Mental Health Programme).  This included assessment interviews and progress notes written by psychologists and psychiatrists at the centre.  The assessment questionnaire comprises three sections. Section 1 (6 items) listed the demographic data (age, sex, marital status, education, occupation, and place of residence), section 2 (8 items) listed the different types of trauma experienced by the patient during his or her lifetime.  The section 3 contained 28 questions consisting of items from the Post-Traumatic Stress Disorder Diagnostic Criteria DSM-III-R modified (Allodi, 1990).  The data was transferred from the files of those patients to the questionnaire.

Results
Demographic Data
The sample included 113 males and 17 females (table 1).  The mean age of the sample was 30 years-old.  The range of age was between 18 and 71years.  63 cases (48.5%) were 18-26 years-old; 34 cases (26%) were 27-35 years-old; 16 cases (12.5%) were 36-44 years-old; 11 cases (8.5%) were from 45-53 years old; 4 cases (3%) were 54-62 years-old; 2 cases (1.5%) were 63-71 years-old (table 1).  93 cases (71.5%) were married; 35 cases (27%) were single; 2 cases (1.5%) were divorced (table 2).  18 cases (13.85%) were illiterate; 43 cases (28.46%) attended elementary school; 27 cases (20.77%) attended primary school; 31 cases (23.85%) attended secondary school; and 17 cases (12.08%) attended institutes of higher education (table 5).  45 cases (34.62%) came from Gaza City and surrounding camps; 42 cases (32.31%) came from the South; 26 cases (20%) came from the Middle area (mostly camps); 16 cases (12.31%) came from the North (table 3).  59 cases (45.38%) were unemployed; 53 cases (40.77%) were simple workers; 11 cases (8.46%) were professionals; and 7 cases (5.38%) were students (table 4).

In our sample 70 cases experienced more than one trauma at the same time.  The most frequent symptoms reported in the PTSD list were recurrent memories of the traumatic event, sleep disturbances, nightmares, avoidance behavior, hyperarausal responses, loss of appetite, weeping, nervousness, conversion fits (table 6).

Conclusion
This study indicates that the most common traumatic events for the patients attending our clinic were beatings, imprisonment, witnessing acts of violence against relatives and non-relatives, being injured by shooting, and inhalation of tear gas.  The most affected age was the middle-aged people.  This reason could be that they are the most active part of the society.  The most common cases were from Gaza City and South area due to presence of the large population in camps (Beach, Rafah and Khan Younis camps).  Those camps faced more clashes then the other areas.
Our results showed us that the Post-Traumatic Stress Disorder symptoms appearance can change in different cultures.  This thesis was supported by observing that 28 cases had developed conversion symptoms in the form of conversion fits.  It has been observed that persons in Eastern culture react to stressful events by exhibiting somatoform symptoms, including conversion fits, motor, sensory, and dissociate ones.

References
Allodi,. (1982).  Psychiatic sequelae of torture and implications for treatment.  Journal of the World Medical ssociation, 29, 71-75.

Abildraard, U. Daugaard, G. Marcussen, H. et al. (1984).  Chronic organic
psychosyndrome in Greek torture victims.  Danish Medical Bulletin, 31, 239-42.

American Psychiatric Association.  (1987).  DSM-III-R. Diagnostic and statistical manual of mental disorders (3rd edition, revised) Washington, DC : American psychiatric association.

Davidson, J.R.T. (1989).  Post-traumatic stress disorder.  In Diagnosis and treatment of anxiety disorders:  Physician handbook  (ed T.J. Mcglynn 7 H.L. Metcalf).  77-84.  Washington. DC :American Psychiatric Press.

Horowitz MJ.  (1976).  Stress response syndromes.  New York : Jason Aronson Inc.

Mollica, R, R.F. Wyshak, G., & Lavelle, J. (1987).  Psychological impact of war trauma and torture on Southeast Asian refugees.  American Journal of Psychiatry 144, 1567-1570.

Ramussen, O.V. (1990).  Medical aspects of torture (sis).  Danish Medical Bulletin, 37, 1-88.

Somnier, M. & Genefke, I.K. (1986).  Psychotherapy for victims of torture.  British Journal of Psychiatry, 149, 323-9.

Wallach, M. & Rasmussen, O.V. (1983).  Torture in Chile  Ugeskrift for Laeger, 145, 2349-52.
 

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